Potentially burdensome end-of-life care for colorectal cancer decedents: A retrospective cohort study

Colorectal cancer is a leading cause of cancer mortality in Australia, with many patients requiring complex end-of-life care. Evidence of potentially burdensome end-of-life care specific to colorectal cancer populations in hospital settings is limited. This study aimed to examine factors associated with indicators of potentially burdensome end-of-life care among people who died from colorectal cancer and received hospital-based care in New South Wales, Australia.

A retrospective population-based cohort study was conducted using linked data from the NSW Cancer Registry, hospital, and mortality records (2014-2019). Adults aged ≥20 years whose underlying cause of death was colorectal cancer and who were hospitalized in their final year of life were included. Multivariable logistic regression models examined associations between patient demographics and all indicators. Multinominal logistic regression examined predictors of a composite indicator comprising 4 indicators of potentially burdensome end-of-life care.

Of 9,476 colorectal cancer decedents, 15.7% died in acute care. Within the last 30 days of life, 13.1% had >1 emergency department presentation, 9.2% had >1 hospital admission, and 3.1% had an intensive care unit admission. The composite indicator identified 71.3% of patients with no indicators, 18.9% with 1, and 9.8% with ≥2 indicators of potentially burdensome end-of-life care. Higher odds of potentially burdensome end-of-life care were observed among people who smoke, people living in rural locations, who had a lower socioeconomic status, a prior cancer diagnosis, or their final admission was to a private hospital. Females, people with comorbidities, and people who had a longer survival duration, had lower odds of potentially burdensome end-of-life care.

Findings highlight socioeconomic and system-level disparities that may inform policy and clinical strategies to improve equitable, patient-centered end-of-life care.